What Is Workers’ Compensation Billing and Collections?
As a small medical practice, navigating the complexities of workers’ compensation billing and collections can be difficult.
In spite of this, to ensure you’re optimizing your revenue and tracking payments with minimal hassle, a proper understanding of this process is fundamental.
So, let’s explore some of the particulars in workers’ compensation billing and collections, as well as some of the strategies you can employ for successful claim management.
Understanding Workers’ Compensation
So, what is workers’ compensation? In essence, it refers to an insurance policy that grants benefits to workers who sustain injuries or illnesses as a result of work-related endeavors.
This can include things like accidents, exposure to harmful substances, or even repetitive strain injuries like carpal tunnel syndrome. Workers’ compensation helps employees and their families during the recovery process, covers medical expenses, and makes up for lost wages too.
Why Does It Matter?
Now, why is it so important for medical practices? Well, healthcare workers face unique risks that need adequate protection from accidents and illnesses that can happen in the workplace.
From infectious diseases to physical strain, there are many hazards in the healthcare industry. And when employees get injured, medical practices can end up with costly medical bills and lost productivity. Having workers’ compensation insurance helps both employers and employees in these situations.
Workers’ compensation also encourages medical practices to make their workplaces safer and healthier. By providing training programs and ergonomic equipment, the risk of workplace injuries and illnesses can be significantly reduced.
This doesn’t just benefit employees, but also helps the practice become more productive and can even lower the cost of workers’ compensation insurance premiums.
How Do Workers’ Compensation Claims Differ From Other Forms Of Insurance?
Workers’ compensation is often confused with other types of insurance, such as health insurance claims or disability insurance. While these insurance types can overlap, workers’ compensation is distinct in several ways.
Firstly, workers’ compensation only covers injuries or illnesses that occur during the course of employment. It does not cover injuries that happen outside of work, or illnesses that are not work-related.
Secondly, as it’s a no-fault system, employees can receive benefits regardless of who is responsible for the injury or illness. This protects employees from having to establish their employer’s culpability to receive benefits.
And lastly, workers’ compensation benefits are predetermined and set by state law. The amount of benefits an employee can receive is based on factors such as the severity of the injury or illness, the employee’s salary, and the length of time they are unable to work.
This is different from health or disability insurance, which may have varying levels of coverage based on the policy. As such, it’s crucial to have proper benefit checking processes.
How Can Medical Practice Owners Stay Current With Workers’ Compensation Regulations?
1. Keep Track Of State & Federal Regulations
First things first, make sure you’re aware of state and federal laws. These regulations can change frequently, so stay on top of any new developments. For example, did you know that California made changes to its workers’ compensation system in 2021, including a new formula to calculate permanent disability benefits?
2. Attend Industry Events & Webinars
Attending industry events and webinars can also be a great way to learn about new regulations and stay updated on any changes. You’ll get to hear from expert speakers who can provide valuable insights into the workers’ compensation landscape.
Plus, you’ll get the chance to ask questions and network with other small medical practice owners.
3. Outsource Medical Billing Services
Finally, consider outsourcing medical billing services. Medical billing companies have a team of experts who are well-versed in the latest regulations and can handle the complex administrative tasks involved in filing claims. This can save you time and money, allowing you to focus on your patients’ needs.
Outsourcing With PMN
PMN specializes in helping small medical practices streamline their processes and maximize their cash flow!
With their comprehensive and flexible solutions for medical practice owners, various tasks like billing, coding, claims processing and patient follow ups are much simpler.
Specifically, they can also assist with a worker’s compensation claim. When a practice is faced with managing all of these claims on their own, their time and resources can become spread thin and their revenue cycle can be impacted. PMN can help ease the burden by providing quality and accurate claims processing, ensuring that all claims are paid on time and minimizing delays.
What Are The Steps Involved In The Worker’s Compensation Claims Process?
Workers’ comp claims can be a complex process, and medical practices must ensure they follow the necessary steps to ensure timely and accurate reimbursement. Here are some of the basic steps involved in the process:
- While on the job, an employee gets injured and reports it to their employer.
- The employer then reports what happened with the injured worker to their insurance carrier and files a workers’ compensation claim .
- The insurance carrier will then investigate the claim to determine its validity.
- Medical treatment is received for their injury.
- The insurance carrier accepts or denies the claim based on their investigation.
- Lastly, if the claim is accepted, the insurance carrier will pay for the medical services and lost wages.
How Can Proper Workers’ Compensation Billing And Collections Increase Revenue For Your Practice?
An effective system in place for workers’ compensation can drive revenue by helping to reduce rejections and denials, reducing accounts receivable days outstanding, and improving the process of coding, pricing and submission.
When your practice uses accurate and up-to-date coding, timely submissions with detailed documentation, and accurate reimbursement, this will increase your chances of receiving full payment for services and reduce administrative costs associated with billing and collection.
Common Mistakes In Workers’ Compensation Billing And Collections
Some of the more typical errors include not documenting the exact procedure performed; using incorrect or outdated codes; failing to submit valid supporting documentation; not following up on denied or unpaid claims; and over or under pricing services.